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  1. Registration-associated patient misidentification in an academic medical center: causes and corrections. | PSNet

    psnet.ahrq.gov/issue/registration-associated-patient-misidentification-academic-medical-center-causes-and
    September 02, 2020 - Study Registration-associated patient misidentification in an academic medical center: causes and corrections. Citation Text: Bittle MJ, Charache P, Wassilchalk DM. Registration-associated patient misidentification in an academic medical center: causes and corrections. Jt Comm J Qual Pat…

  2. Overcoming COVID-19: what can human factors and ergonomics offer? | PSNet

    psnet.ahrq.gov/issue/overcoming-covid-19-what-can-human-factors-and-ergonomics-offer
    September 02, 2020 - Commentary Emerging Classic Overcoming COVID-19: what can human factors and ergonomics offer? Citation Text: Gurses AP, Tschudy MM, McGrath-Morrow S, et al. Overcoming COVID-19: what can human factors and ergonomics offer? J Patient Saf Risk Manag. 2020;25(2):49…

  3. Laboratory medicine handoff gaps experienced by primary care practices: a report from the Shared Networks of Collaborative Ambulatory Practices and Partners (SNOCAP). | PSNet

    psnet.ahrq.gov/issue/laboratory-medicine-handoff-gaps-experienced-primary-care-practices-report-shared-networks
    September 01, 2012 - Study Laboratory medicine handoff gaps experienced by primary care practices: a report from the Shared Networks of Collaborative Ambulatory Practices and Partners (SNOCAP). Citation Text: West DR, James KA, Fernald DH, et al. Laboratory medicine handoff gaps experienced by primary care p…

  4. Association between limiting the number of open records in a tele-critical care setting and retract-reorder errors. | PSNet

    psnet.ahrq.gov/issue/association-between-limiting-number-open-records-tele-critical-care-setting-and-retract
    July 22, 2020 - Study Association between limiting the number of open records in a tele-critical care setting and retract-reorder errors. Citation Text: Udeh C, Canfield C, Briskin I, et al. Association between limiting the number of open records in a tele-critical care setting and retract–reorder error…

  5. Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing on residents' emergency care use. | PSNet

    psnet.ahrq.gov/issue/do-not-pimp-my-nursing-home-ride-impact-potentially-inappropriate-medications-prescribing
    March 17, 2021 - Study Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing on residents' emergency care use. Citation Text: Rapp T, Sicsic J, Tavassoli N, et al. Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing…

  6. Adverse outcomes of polypharmacy in older people: systematic review of reviews. | PSNet

    psnet.ahrq.gov/issue/adverse-outcomes-polypharmacy-older-people-systematic-review-reviews
    May 29, 2019 - Review Classic Adverse outcomes of polypharmacy in older people: systematic review of reviews. Citation Text: Davies LE, Spiers G, Kingston A, et al. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020;21(2):1…

  7. Effect of illness severity and comorbidity on patient safety and adverse events. | PSNet

    psnet.ahrq.gov/issue/effect-illness-severity-and-comorbidity-patient-safety-and-adverse-events
    December 01, 2011 - Study Effect of illness severity and comorbidity on patient safety and adverse events. Citation Text: Naessens JM, Campbell CR, Shah ND, et al. Effect of illness severity and comorbidity on patient safety and adverse events. Am J Med Qual. 2012;27(1):48-57. doi:10.1177/1062860611413456…

  8. Differences between methods of detecting medication errors: a secondary analysis of medication administration errors using incident reports, the Global Trigger Tool method, and observations. | PSNet

    psnet.ahrq.gov/issue/differences-between-methods-detecting-medication-errors-secondary-analysis-medication
    December 18, 2019 - Study Emerging Classic Differences between methods of detecting medication errors: a secondary analysis of medication administration errors using incident reports, the Global Trigger Tool method, and observations. Citation Text: Härkänen M, Turunen H, Vehviläine…

  9. The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities. | PSNet

    psnet.ahrq.gov/issue/effects-crew-resource-management-teamwork-and-safety-climate-veterans-health-administration
    December 11, 2024 - Study The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities. Citation Text: Schwartz ME, Welsh DE, Paull DE, et al. The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facil…

  10. A blinded, prospective study of error detection during physician chart rounds in radiation oncology. | PSNet

    psnet.ahrq.gov/issue/blinded-prospective-study-error-detection-during-physician-chart-rounds-radiation-oncology
    November 16, 2022 - Study A blinded, prospective study of error detection during physician chart rounds in radiation oncology. Citation Text: Talcott WJ, Lincoln H, Kelly JR, et al. A blinded, prospective study of error detection during physician chart rounds in radiation oncology. Pract Radiat Oncol. 2020;…

  11. Insurance claims for wrong-side, wrong-organ, wrong-procedure, or wrong-person surgical errors: a retrospective study for 10 years. | PSNet

    psnet.ahrq.gov/issue/insurance-claims-wrong-side-wrong-organ-wrong-procedure-or-wrong-person-surgical-errors
    October 20, 2021 - Study Insurance claims for wrong-side, wrong-organ, wrong-procedure, or wrong-person surgical errors: a retrospective study for 10 years. Citation Text: Vacheron C-H, Acker A, Autran M, et al. Insurance claims for wrong-side, wrong-organ, wrong-procedure, or wrong-person surgical errors:…

  12. Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center | PSNet

    psnet.ahrq.gov/issue/lessons-learned-implementing-complex-and-innovative-patient-safety-learning-laboratory
    August 03, 2022 - Study Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center Citation Text: Businger AC, Fuller TE, Schnipper JL, et al. Lessons learned implementing a complex and innovative patient safety learning laboratory p…

  13. Private patient rooms and hospital-acquired methicillin-resistant Staphylococcus aureus: hospital-level analysis of administrative data from the United States. | PSNet

    psnet.ahrq.gov/issue/private-patient-rooms-and-hospital-acquired-methicillin-resistant-staphylococcus-aureus
    March 11, 2020 - Study Private patient rooms and hospital-acquired methicillin-resistant Staphylococcus aureus: hospital-level analysis of administrative data from the United States. Citation Text: Park S-H, Stockbridge EL, Miller TL, et al. Private patient rooms and hospital-acquired methicillin-resista…

  14. Diagnostic errors by medical students: results of a prospective qualitative study. | PSNet

    psnet.ahrq.gov/issue/diagnostic-errors-medical-students-results-prospective-qualitative-study
    May 18, 2022 - Study Diagnostic errors by medical students: results of a prospective qualitative study. Citation Text: Braun LT, Zwaan L, Kiesewetter J, et al. Diagnostic errors by medical students: results of a prospective qualitative study. BMC Med Educ. 2017;17(1):191. doi:10.1186/s12909-017-1044-7.…

  15. Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: a systematic review and meta-analysis. | PSNet

    psnet.ahrq.gov/issue/effectiveness-continuous-or-intermittent-vital-signs-monitoring-preventing-adverse-events
    July 19, 2023 - Review Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: a systematic review and meta-analysis. Citation Text: Cardona-Morrell M, Prgomet M, Turner RM, et al. Effectiveness of continuous or intermittent vital signs monitorin…

  16. Concept and development of a discharge alert filter for abnormal laboratory values coupled with computerized provider order entry: a tool for quality improvement and hospital risk management. | PSNet

    psnet.ahrq.gov/issue/concept-and-development-discharge-alert-filter-abnormal-laboratory-values-coupled
    June 27, 2018 - Study Concept and development of a discharge alert filter for abnormal laboratory values coupled with computerized provider order entry: a tool for quality improvement and hospital risk management. Citation Text: Mathew G, Kho A, Dexter P, et al. Concept and development of a discharge a…

  17. Prevalence of copied information by attendings and residents in critical care progress notes. | PSNet

    psnet.ahrq.gov/issue/prevalence-copied-information-attendings-and-residents-critical-care-progress-notes
    September 28, 2017 - Study Prevalence of copied information by attendings and residents in critical care progress notes. Citation Text: Thornton D, Schold JD, Venkateshaiah L, et al. Prevalence of copied information by attendings and residents in critical care progress notes. Crit Care Med. 2013;41(2):382-…

  18. Enhancing patient safety in prehospital environment: analyzing patient perspectives on non-transport decisions with natural language processing and machine learning. | PSNet

    psnet.ahrq.gov/issue/enhancing-patient-safety-prehospital-environment-analyzing-patient-perspectives-non-transport
    September 20, 2017 - Study Enhancing patient safety in prehospital environment: analyzing patient perspectives on non-transport decisions with natural language processing and machine learning. Citation Text: Farhat H, Alinier G, Tluli R, et al. Enhancing patient safety in prehospital environment: analyzing p…

  19. Race, ethnicity, and 60-day outcomes after hospitalization with COVID-19. | PSNet

    psnet.ahrq.gov/issue/race-ethnicity-and-60-day-outcomes-after-hospitalization-covid-19
    January 12, 2022 - Study Race, ethnicity, and 60-day outcomes after hospitalization with COVID-19. Citation Text: Robinson-Lane SG, Sutton NR, Chubb H, et al. Race, ethnicity, and 60-day outcomes after hospitalization with COVID-19. J Am Med Dir Assoc. 2021;22(11):2245-2250. doi:10.1016/j.jamda.2021.08.023…

  20. Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital. | PSNet

    psnet.ahrq.gov/issue/effect-medication-reconciliation-and-without-patient-counseling-number-pharmaceutical
    May 26, 2021 - Study Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital. Citation Text: Karapinar-Carkit F, Borgsteede SD, Zoer J, et al. Effect of medication reconciliation with and without p…
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